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Moving the blog to a new URL :) WOO HOO!

September 22, 2010

I have been able to ‘upgrade’ a little and move the blog to its rightful URL. Don’t worry, it will be the same.

http://www.nursestory.com

See you there!

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Looking for input: The librarian’s work in online courses and in BSN completion programs

August 8, 2010

I am looking for literature articles, personal anecdotal information, and input from faculty and librarians as to what works and what you are dreaming of doing to support online education from the perspective of library science and nursing. I am looking for input as to where I should look for studies, or even designs for the online library. If any of you have input feel free to comment here or DM me on twitter @onlinenursing.

Also, how are you all teaching your students to search and utilize electronic library resources?

Part 2: Drooling, Sharing, Playing…. communicable diseases that can plague the preschool ministry

July 22, 2010

Part one of this series covered some basic suggestions for maintaining health, safety, and developmentally appropriate church preschool areas. In this posting, I will briefly review common communicable childhood illnesses, basic signs and symptoms, how these illnesses are passed on to others, and, more importantly, how they can be prevented. This posting is not meant to be medical advice, leave that to the families you serve and their health care provider. Instead, this posting is meant to be more of an informational… ‘what to watch out for and help prevent’. After all, if the church is not foremost in public health, then who will be?

Skin Infections: Two of the most common skin infections in children are Staphylococcus and Streptococcus bacterial infections. Some of the common results of these bacteria in children are impetigo, folliculitis, cellulitis, and abscesses. Often children create their infections by scratching, making tiny micro-cuts in the skin and introducing all of the bacteria on their fingers and under fingernails. Bug bites are common initial culprits for creating ‘itches’, as are runny noses that can cause a break down of skin integrity under the nose. Common symptoms arise from local inflammation and can include redness, warmth, tenderness, and even blisters or open wounds. These are often contained to a single area, but can spread through contact to other open wounds and other children with open wounds.

PREVENTION: HAND WASHING is THE most effective measure for preventing spread or even warding of initial infection. This is particularly important as much of the Staphlococcal bacteria has now become resistant to many common antibiotics (AKA M.R.S.A.).

Acute Pharyngitis (sore throat): Any throat infection is considered to be an upper respiratory tract infection, since the upper airway is involved. Often, in preschool children these infections are viral, but confirmation of this by a health care provider is top priority. The one bacteria that does plague the throat infection world is Group A Streptococcal Pharyngitis, or Strep Throat. Uncommon before the age of 2, this infection of the throat comes on quickly with low grade fever and sore throat, but they may also have an upset stomach, vomiting, lack of interest in food, or even a fine, red, lacy rash. Any child with any of these symptoms should not be allowed into the preschool area (see my previous post on preschool health).

PREVENTION: Having a policy of when to bring and not bring children, hand washing, covering mouths and noses during coughing and sneezing, and preventing children from sharing drinks or snacks will cut down on the direct exposure to Group A Strep. Further, washing toys down with a disinfectant (like a 1:4 solution of white vinegar:water) and letting them air dry cuts down on both viral and bacterial transmission and keeps toxic cleaners to a minimum.

The Common Cold: Most of the bugs that cause a cold are viral with the greatest occurrences fall to spring. Most colds are relativity minor, but RSV and Influenza can manifest early as common colds and turn into much more serious viral illnesses with significant consequences. Prevention is key, but with that being said the average number of colds that a young child has in a year is six. Symptoms of a cold include a slower onset, with often an early sore throat followed by congestion, runny nose, and sometimes cough or low grade fever.

PREVENTION: These viruses are spread by ‘droplet’ contact, meaning that when someone coughs, sneezes, or wipes their nose they can introduce virus into the environment. That is why a combination of prevention of respiratory spread through good manners and covering coughs or sneezes, frequent nose wiping, and frequent hand washing of all is critical. Likewise, as aforementioned, after each preschool class disinfecting the toys is highly suggested.

Gastroenteritis (‘the stomach bugs’): Vomiting and diarrhea can be caused by viruses or bacteria. The concern with these diseases are how easily they are spread and how quickly they can make a small child critically ill. Death from diarrheal illness is a leading cause of childhood death in many countries and the U.S. has its fair share of hospitalizations and death from such illnesses. Dehydration leading to hypovolemic shock is the ultimate culprit in such deaths. The symptoms are self explanatory, but assessing how hydrated a child is should be done through contact with a child’s health care provider. Lack of wet diapers, lack of tears, and listless behavior are the ‘way too late’ warning signs and warrant the need for immediate medical intervention.

PREVENTION: Spread of gastrointestinal diseases often comes through oral-fecal transmission, meaning dirty hands touch something that might go into another person’s mouth, and let’s face it if you are under 3 years old… everything goes into your mouth. Good hand washing by preschool workers and children after toileting or diaper changing is key. I would even suggest limiting lots of costume jewelery and fake finger-nails by preschool staff as all of these can harbor germs, but I understand if you do not want to be too prescriptive. Gloves for diaper changes, maintaining all diaper supplies being in easy reach and at the ready so that staff are not having to open drawers with possibly contaminated hands, keeping diaper garbage and even the garbage cans up out of the reach of crawlers, disinfecting diaper changing areas after each use, and keeping plastic bags to tie off soiled clothing and spare clothing for accidents is recommended.

— Pediculosis (lice): These fun little creatures are passed from person to person most often through close contact and sharing of hats, jackets, brushes, combs, etc… Often, preschool children are not social enough to pass these to friends, but can obtain them from older siblings. Treatment and diagnosis should be undertaken by parents in conjunction with their health care providers. Female lice lay as many as 10 eggs a day and can live for a month. The eggs are the culprit and are firmly attached to the hair shaft and have to be manually removed. Lice like warm dark spots, much like bacteria, and thus they often lay eggs behind ears and at the base of the neck.

PREVENTION: Not sharing hats, brushes, combs, or jackets with hoods. At home keeping linen clean and dried in a dryer, and even blow drying the hair can help (as heat kills the little guys).

— A Word on vaccine preventable diseases: Your preschool personnel or director should be familiar with vaccine preventable diseases that are reported to local health departments, because if they come through your department you may be responsible for notifying all of the parents that their children were exposed. So, be familiar with public health law in your state and county. Further, recent outbreaks of measles, pertussis, and chicken pox make these diseases more common.

Overall, if I could impart any advice it would be to disinfect toys after each class, good hand washing, well laid out diaper changing areas, and working on staff and students to have ‘good manners’ when it comes to coughing and sneezing. Further, good communication with parents about your efforts to keep their kids healthy will go a long way! Pick good nurse partners from your congregation to help you keep your preschool ministry safe and healthy.

References:

Behrman, Kliegman, Jenson (2004). Nelson Textbook of Pediatrics 17th Ed. W.B.Saunders.

Ecuador Trip 2010

July 12, 2010

We went again, we changed focus some, we learned a lot.

Again this year 15 student nurses, nurses, and lay people gave up time, money, and their common creature comforts to follow me to areas around Quito, Ecuador for health care mission. This year it was just us nurses. I was quite proud. We saw over 400 people in 4 days, but the clinic and health screenings were not the most important part. This year, because we are nurses, we did public health. Hand washing and dental hygiene education, handing out anti parasite medications, and providing tooth brushes, tooth paste, and vitamins to entire schools of children was our greatest accomplishment. In such activity we build sustainable health change and help others to continue health practices long after we are gone. Although the students felt like this portion was not really the hard or fun work, it was by far the most important.

Here are just a few things we learned this year:

  • That nurses are very good at picking up abnormals.
  • That nurses make good teachers of health.
  • That each person on a team has a different job and that each of those jobs is equally important (none of clinic could get done if even one person had been missing)
  • That access to health care does not mean that one can afford the medications.
  • That a little time listening, Tylenol, and TLC goes a long way in building relationships.
  • That we take WAY too many things for granted… like warm water, clean water, flushing toilet paper, going anywhere we want at about any time, and that we are not nearly as content as we should be.
  • That there are so many other people who give so much more than we do, out of love, to make this world a better place.
  • Humility.

To all of you who supported us in any form, thank you. To the people of Ecuador, thank  you. To the patients who taught us humility, thank you. Hopefully we will all come together again in that great country!

Drooling, playing, sharing… a nurse’s recomendations for church preschool ministries

June 17, 2010

I am going to start a series of posts about health, nursing, and church preschool ministries. For those of you who serve in the preschool area, be it volunteer, baby holder, teacher, or preschool minister…. GOD BLESS YOU! There is an art to that service, and a lot of sharing, putting things in one’s mouth, snacks, diapers, hand washing, separation anxiety, hitting, biting, … you get the idea. Preschool workers must have the patience of Job!

After doing an extensive internet and literature search on “church health”, “preschool ministry health”, and “preschool ministers and health” (and several other variations of health and children)…. I found very little. This led me to believe that there is little information out there on the important subject of keeping kids healthy within the preschool area. Further, many churches may be feeling the economic pinch, have small congregations that cannot afford a preschool minister, or may even believe that rearing children is ‘women’s work’ thus any woman will do to run the ministry as long as she is God-fearing (no discrimination intended guys… you all make some of the BEST preschool workers).

While a love for kids, service, and the Lord may be imperative for preschool ministry, the birth to school aged years are a particularly important time for not only growth and development but health.

I will write later about the church’s service to families of preschoolers with health needs, but for now I just want to begin with some food for thought in building a good, safe, healthy preschool ministry. (AND when I say healthy I am not talking about spiritual health…. I mean good grief, Googling health and ministry together get’s a lot of gobbeldy goop about spiritual health.)

Things to consider when building a healthy preschool/nursery ministry:

  • Setting rules about when kids are not allowed. Although this seems like an authoritarian way to begin, it’s really a way to help keep all the kids you serve and their families healthy. Many states’ daycare guidelines have good ideas of where to start on this subject, so check out your state daycare recommendations. I would begin with stating something like; any kid with rash, vomiting, diarrhea, or a fever over 100 degrees Fahrenheit within the last 24 hours should not be brought to the nursery or preschool area.  Then, make this regulation known to parents in a loving but clear way. An introduction packet the first time the bring their child, or posting this on the door of the nursery/toddler room. Remember, be gentle but clear. Something like, “We love your children and want to keep them healthy. The best way to do that is for all of us to work together. We promise to help keep the room clean, enforce hand washing, etc…. and ask that you help us by the following….” Then put in the part about not bringing your child when they are ill.
  • Educate your preschool staff about common childhood communicable diseases, not so they can diagnose, but so they can recognize and keep themselves healthy. Many common childhood illnesses are viral and cannot be cured with antibiotics. The most serious childhood illnesses commonly have vaccine prevention. However, many parents are choosing not to immunize their children. These parents are the middle to upper class Americans, and while I am not condoning or condemning this choice and neither should the preschool staff, it does create greater risk within the preschool area. Immunization is not a 100% guarantee that a disease will not be caught/transmitted (however it really increases the chances of not catching a disease) and thus those who may get and carry a disease can pass it on to an immunized person. Also, some immunizations only provide immunity for several years. Many adults are no longer immune against pertussis, diphtheria, measles, mumps, etc. With recent outbreaks of mumps, pertussis, and measles within the U.S., recognition and education of everyone about communicable disease is important. (I will write a future post with the signs and symptoms of the most communicable and common childhood illnesses.)

With the recent recommendations for pertussis and diphtheria immunization with tetanus boosters (In medical jargon this is called a TDaP), you may want to consider asking your preschool staff to ensure they have their booster. For example, one un-immunized healthy kid may come into the preschool area and interact with a staff member who had bronchitis several weeks ago, but now has a cough hanging on (common with pertussis/whooping cough). That worker, who will shed pertussis virus for several weeks post acute infection now has exposed that un-immunized child.

  • Keep a first aid kit easily accessible but out of the reach of children. A first aid kit is a must. In it should be the following: Bandaids, gloves, some antibacterial soap to clean wounds with (NOT HAND GELL), larger bandage pads to soak up blood if needed, some bandage tape, incident report sheets, a frozen sponge in a zip-lock bag (kept in the freezer) and liquid benadryl (diphenhydramine) with a standard dosage chart. Gloves are obvious, use them when cleaning and treating any open wound. Bandaids are obvious and work to make many ouchies feel better. Antibacterial hand soap (in a pump, so it carries less germs) is a must to clean a wound. Use it with water and let air dry (never blow on a cut, it introduces bacteria). I do not recommend antibacterial ointment for cuts, parents can do that at home and many kids now have allergies to antibiotics due to frequent exposure. Larger wound pads to soak up blood or to dress bigger cuts and tape to make it stick. Slightly damp, frozen sponges make excellent ice packs and can be reused over and over… simply put a new zip-lock around it between each use.  Should an allergic reaction or hives occur in someone in the preschool benadryl is the medication of choice. You would never dose without the parent/guardian there to do it themselves, but it is great to have handy and anyone can swallow the liquid form.  Finally, incident reports should be little sheets of paper that the adult in the room can fill out and give to parents when any ouchy, even if minor, has occurred. This keeps parents in the loop and helps them feel a part of the team. No one wants to hear from their child in the car on the way home from church, “Little Tommy hit me in the head with a block today and made me cry”.
  • Hand washing, hand washing, hand washing…. Both kids and adults, put up signs, pictures, etc…. Enough said.
  • Conform to recommended teacher to child-ratios for nurseries and preschools set by your state and let parents know you do this. There is nothing more frightening for a parent than to turn their children over to strangers for 2 hours of time, but it is even more frightening if the room is packed with kids and there is only one adult trying to hold it all together. Further, there is nothing scarier or more frustrating for nursery staff than to be the only adult in a room of 20 preschoolers (Even 2 adults in such a room is too few). Not only will this drive parents and volunteers out of your church faster than you can say ‘boo’, but it is extremely dangerous. What if one child is climbing on the sink while another is biting? What if you have two fighting in the corner while this is going on? There need to be eyes on the kids at all times. In fact, I would say that going to an even smaller student to teacher ratio than what your state recommends is highly advised. (FYI, counting people who check kids in and out or run other areas of the preschool and nursery do not count in staffing for rooms.)
  • Consider allergies. All kids, whether long-time attenders or newbies need allergy and other important information. Consider keeping file cards on each child or stickers on the ones with allergies to alert anyone that comes into contact with them (this works well if you are changing teachers/volunteers frequently). Keep this information accessible to all volunteers in the area, but also confidential if the parent wishes. HAVING SAID THIS…. do not let allergies keep you from being creative (the next area). While peanut allergies are common and you may not want to serve any snacks that even have a hint of nuts (this would include any processed chocolate)… You also DO NOT want to serve the same thing all the time and bore the kids out of their mind. Pretzels every week, YUCK! Likewise, if the allergy the child has is severe and requires epinephrine treatment immediately upon exposure, then the parents MUST ensure that the epinephrine injector set is sent with the child every week and that someone in the preschool area is trained to use it. Since we cannot control everything in every environment, or everything that goes into a kid’s mouth, someone other than the parents, because often parents may be difficult to track down, must know be trained in using epinephrine auto-injectors. The child’s life may depend on it. Also, encourage these parents to pack their kids a snack, so the kids do not miss out and yet the parents will feel safe about what the kids are getting.
  • Keep it creative. This is a child development issue, but also one that if not followed can create bored kids… and bored kids may find mischief. Make rooms safe (like no tall book shelves, folding chairs, small toys that can be swallowed, if there is a sink make sure the hot water does not get over 120 degrees, etc…), but inviting, ensure there are plenty of toys to share, do more than a coloring page every week, have structure but creativity. Kids like to explore, feel, touch, taste (as they learn)… so do not expect them to sit still and color or listen to a story without pictures. Further, allow your staff to be creative and expand within the curriculum and let them prepare ahead of time.
  • Consider special needs kids. Often parents who have children with special needs do not send their children to a preschool area because they are fearful for many reasons. Consider a specialized program for these kids where you put them with a secure one-on-one adult buddy every week who helps them, builds trust, knows their needs, and can help them into a class with other kids their age. Or consider a specialized class for a certain population you may serve. Consider translators when needed and use congregational nurses, occupational/physical therapists, and child development experts to help you design or implement such programs (these people are often looking for ways to use their educational gifts within a congregation).

These tips are certainly not the entirety of safety and health in the preschool area, but it does provide some ideas for thinking about the importance of this population in a church congregation. Often churches have adult ministers, youth ministers, music ministers, etc… but leave the nursery and preschool as an area that can take care of itself. Careful planning, communication, and education will help make parents feel better and help keep kids safe.

More later on other similar topics….

#RNChat and Social Media: Future of Nursing from RWJF

May 25, 2010

The great people at the RWJF, who use social media to inform nursing well, posted an article this week with some great insight by Phil Baumann on social media and nursing. They asked me a few questions too, but Phil did a wonderful and eloquent job of clearly laying out why nurses need to be social media savvy. Thank you RWJF and INQRI!!!!!

http://www.rwjf.org/humancapital/product.jsp?id=63768&cid=xtw_rwjf

Tri-Council on Nursing: Great work on education by four U.S. nursing organizations (AACN, NLN, ANA, AONE)

May 22, 2010

I received this in an e-mail this week and then did a search for it on the web and could not find it easily as a press release or policy statement, but the policy is found on the AACN website homepage. This topic was important enough I thought I would share the e-mail press release. Besides the fact that it is called a tri-council with four organizations, it is an excellent read. I hope it is a push forward for standardized nursing education and entry to practice. GO NURSING!

In light of the recent passage of healthcare reform legislation, the Tri-Council for Nursing, has issued a consensus statement calling for all registered nurses to advance their education in the interest of enhancing quality and safety across healthcare settings. (see attached for complete statement).

The Tri-Council for nursing includes the following organizations:

  • American Association of Colleges of Nursing (AACN),
  • American Nurses Association (ANA),
  • American Organization of Nurse Executives (AONE), and
  • National League for Nursing (NLN)

In the policy statement, the Tri-Council organizations state:

Current healthcare reform initiatives call for a nursing workforce that integrates evidence-based clinical knowledge and research with effective communication and leadership skills. These competencies require increased education at all levels. At this tipping point for the nursing profession, action is needed now to put in place strategies to build a stronger nursing workforce. Without a more educated nursing workforce, the nation’s health will be further at risk.

Nurses with advanced education are needed in large numbers to serve as teachers, scientists, primary care providers, specialists, and leaders throughout the healthcare delivery system. The Tri-Council encourages all nurses, regardless of entry-point into the profession, to continue their education in programs that grant baccalaureate, master’s, and doctoral degrees. A wide variety of education options exist to further the preparation of today’s nursing workforce, including degree-completion, online, accelerated, and part-time degree programs.

The Tri-Council was compelled to issue this statement following an assessment of how best to prepare nurses for contemporary practice. Participating organizations, which represent nurses in practice, research, and academic settings, deliberated on many issues, including the need to meet workforce demands and prepare nurses for new models of practice; the complexity of the healthcare environment and patient care needs, and the imperative to address the nurse faculty shortage, which is limiting enrollment capacity in schools of nursing.

The policy statement ends with a call to action which advocates for system changes in nursing practice and education; for nurses to understand the importance of academic progression and embrace lifelong learning; and for policymakers at the state and federal levels to fund programs and launch collaborative initiatives that facilitate nurses seeking to advance their education.